Community services team

We continue to develop our community services and currently have a team of 13 staff dedicated to working with people affected by substance misuse. Approximately 90% of chronic hepatitis C infections acquired in the UK are among people who inject drugs or who have injected drugs in the past. Joint development and implementation of patient centred hepatitis C interventions with providers such as Addaction, CGL, Turning Point, Changing Lives & Humankind will be crucial in realising the Trusts aim of elimination within the UK. The Trust works in partnership with these organisations to deliver the following interventions within drug service settings:

Staff Training

Drug workers in the UK are often the first and only point of care for people affected by substance misuse. The level of trust that is built up between the worker and the service user provides the best opportunity to deliver healthcare messages. It is therefore essential that staff at drug services have a good understanding of hepatitis C. Testing uptake is hugely dependent on the skills, knowledge and confidence of the staff offering the test. Staff confidence in this area also generates a greater adherence by service users to ongoing care referral pathways.

The Trust provide a range of workforce development training packages to nationwide community service providers. Ultimately staff should be:

· Knowledgeable about safer practice

· Confident in discussing and offering hepatitis C testing

· Knowledgeable about the referral process

· Knowledgeable about local integrated care pathways to support

· Knowledgeable about the new treatment for hepatitis C

Peer to Peer Education

Peer-led education shows that individuals can learn more effectively from within their own peer group. Research has shown that peer educators can have a greater validity and empathy with clients because they have direct experience of the problems they are facing. Consequently, they are more likely to engage with people who would otherwise be unlikely to access services, and can support them more effectively.

The Hepatitis C Trust has run a peer-to-peer education (P2P) programme since August 2010. Peer educators with lived experience of hepatitis C are trained to deliver workshops and share their life story which includes the importance of testing and attending hospital appointments. This increases testing numbers and the likelihood of diagnosed patients going on to access specialist monitoring and where appropriate, treatment. The programme provides key messages about hepatitis C prevention, diagnosis, treatment and care to people accessing drug services, hostels and homeless shelters.

Through partnership work with Addaction, one of the UK’s large drug service providers, we investigated if a sustainable peer led model could be implemented within service delivery. This was successful, and has led to our P2P programs being adopted throughout services in the UK. The Trust oversees the management of these programs.

Follow Me

Drug services have played a major part in diagnosing hepatitis C patients with most services being commissioned to offer at least 90% of their service users a test for hepatitis C. Of these, all those who are hepatitis C positive should be referred to see a consultant at their local hospital. However, there are still a significant number of service users remaining undiagnosed and, more importantly, not engaging with specialist care when known to be positive for hepatitis C.

Our Follow Me programme offers a buddying service whereby we train and support selected volunteers to personally support people through testing, treatment and care. In services where we have implemented this program, the offer of peer support is made after every positive diagnosis of hepatitis C. A peer will accompany each individual to their hospital appointment, and throughout their treatment episode. Peers also help patients to digest and understand some of the complex language used as they progress through the care pathway.

Pathway Coordination

With initial funding from Comic Relief, we have developed a role tasked with improving the care pathways for drug users at risk of hepatitis C. The pathway coordinator conducts an initial audit of hepatitis C service delivery alongside major drug service providers, reviewing existing work and ensuring its continuance, and implementing the learned best practice into their broader service delivery. Recommendations are made for improvement as well as identifying and coordinating the delivery of any additional interventions required. The pathway coordinator documents local pathways so that providers can understand them, staff knowledge that these pathways exist is essential.

For the past 10 years we have pushed for healthcare providers to adopt a model of ‘treatment in the community’, offering hepatitis C treatment to people in settings that are much easier for them to access. Through successful partnership working with NHS England and providers of community drug services we have been able to support the development of this model which is now commonplace in the UK. The long term aim is that the clinical staff within drug services will prescribe and administer hepatitis C treatment within its own services, offering people a choice other than having to visit a treatment centre.

Contact details

If you would like any further information on the work of the drug services team or would like to discuss how they might support the work of your service, contact Stuart Smith stuart.smith@hepctrust.org.uk or call him on 020 7089 6223.